Provider Demographics
NPI:1679620827
Name:WAKSMAN, MILANA (MPT)
Entity type:Individual
Prefix:
First Name:MILANA
Middle Name:
Last Name:WAKSMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12526 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3409
Mailing Address - Country:US
Mailing Address - Phone:818-985-2559
Mailing Address - Fax:818-985-4459
Practice Address - Street 1:12526 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3409
Practice Address - Country:US
Practice Address - Phone:818-985-2559
Practice Address - Fax:818-985-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-25978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist